| NPI | 1265477343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34-007519) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: OH 34.007519) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2019-05-23 |